The title of this project is Eliminating Catheter-Associated Blood Stream Infections (CA-BSIs) in Chronic Central Lines. The overall goal of the proposed research is to determine whether best practice care bundles for the management of acute central lines in pediatric intensive care units (PICU) can be tailored and disseminated to the pediatric hematology / oncology population to reduce catheter-associated bloodstream infections in this high-risk population with chronic central lines. The National Association of Children's Hospitals and Related Institutions has developed, sustained, and spread a quality improvement collaborative focused on the elimination of CA-BSI among patients with acute central lines in the PICU. After three years, the average CA-BSI rate across PICUs has dropped dramatically from 5.5 infections per 1,000 central line days to approximately 1 infection per 1,000 central line days. Despite this, it remains unknown what best practices should be with chronic central venous catheters outside the ICU setting. Our proposal will address this by working with 25 children's hospitals to reduce central line infections among children with oncologic and chronic hematologic conditions with chronic central venous catheters. Successful completion of this project will provide the Agency for Healthcare Research and Quality, providers, patients, payers, and policymakers with effective tools for spreading CA-BSI eradication efforts outside ICUs to the large population of patients with chronic central lines. This knowledge for best care of chronic central lines is the logical first step to eliminating central line infections in all chronic care settings including the home and ambulatory arenas. PUBLIC HEALTH RELEVANCE: The overall goal of the proposed research is to determine whether best practice care bundles for the management of acute central lines in intensive care units can be tailored and disseminated to the general care pediatric hematology / oncology population and reduce catheter-associated bloodstream infections in this high- risk population with chronic central lines. Our proposal will accomplish this by partnering with 25 children's hospitals. Successful completion of this project will provide the Agency for Healthcare Research and Quality, providers, patients, payers, and policymakers with effective tools for spreading CA-BSI eradication efforts outside ICUs to the large population of patients with chronic central lines.